Bloodborne Pathogens Training

1. Bloodborne Pathogens Training Meeting WISHA Training Requirements To meet the WISHA training requirements for bloodborne pathogens training, you must include information specific to your worksite. See the notes section of the slides (PowerPoint Notes Pages view). Preview this program and include your specific workplace information before conducting the training. Distribute or make accessible to employees copies of the Occupational Exposure to Bloodborne Pathogens Chapter 296-823 WAC. You must keep an attendance roster for your records to document training.

2. Bloodborne Pathogens Training • How To Use This PowerPoint Program • Users with PowerPoint can download, edit, and use the program for training with a laptop and multimedia projector. • Additional information is also found in the Notes section accompanying the slides. You can read the text in quotations found in the Notes section or use your own words. • If you want to print out this program, the PDF file uses less computer memory and prints faster.

3. Bloodborne Pathogens Training Feb. 2004

4. Bloodborne Pathogens Training Washington Industrial Safety & Health Rules Chapter 296-823 WAC

5. What are Bloodborne Pathogens (BBPs)? Why are they harmful? How can I protect myself? What is (DigiPen)’s Exposure Control Plan? Course Objectives

6. General overview E. coli (bacteria) Trichinella (parasite) PATHOGEN: a microorganism that can cause disease *Image courtesy Indigo Instruments. Visit http://www.indigo.com for more original content like this. Reprint permission is granted with this footer included.*

7. Transmission of Diseases Organisms can enter the body via Note: This slide is animated • Inhalation Air • Inhalation Air • Ingestion Contaminated food, water • Contact Bloodborne

8. Bloodborne Pathogens (BBPs) Present in Blood Other Potentially Infectious Materials or

9. Bloodborne Pathogens (BBPs) OPIM • semen • vaginal secretions • body fluids such as pleural, cerebrospinal, pericardial, peritoneal, synovial, and amniotic • saliva in dental procedures (if blood is present) • any body fluids visibly contaminated with blood • body fluid where it is difficult to differentiate • any unfixed tissue or organ (other than intact skin) from a human (living or dead) • HIV- or HBV-containing cultures (cell, tissue, or organ), culture medium, or other solutions • blood, organs, & tissues from animals infected with HIV, HBV, or BBPs

10. Transmission of BBPs Bloodborne Pathogens can enter your body through • a break in the skin (cut, burn, lesion, etc.) • mucus membranes (eyes, nose, mouth) • sexual contact • other modes

11. Transmission of BBPs Risk of infection depends on several factors: • The pathogen involved • The type/route of exposure • The amount of virus in the infected blood at the time of exposure • The amount of infected blood involved in the exposure • Whether post-exposure treatment was taken • Specific immune response of the infected individual Courtesy of Owen Mumford, Inc.

12. Bloodborne Pathogen Diseases Some examples of bloodborne pathogens: • Malaria • Syphilis • Brucellosis • Leptospirosis • Arboviral infections • Relapsing fever • Creutzfeld-Jakob Disease • Viral Hemorrhagic Fever

13. Viral Hepatitis - General Overview The liver is a large, dark red gland located in the upper right abdomen behind the lower ribs. It functions in removing toxins (poisons) from the blood, in the digestion of fats, and in other body processes. Courtesy of Schering Corporation • Virus attacks liver  inflammation, enlargement, and tenderness • Acute and chronic infections • Possible liver damage ranging from mild to fatal

14. Hearty - can live for 7+ days in dried blood 100 times more contagious than HIV Approximately 78,000 new infections per year (2001) 1.25 million carriers 5,000 deaths/year No cure, but there is a preventative vaccine HBV - Hepatitis B General Facts

15. HBV - Hepatitis B Clinical Features

16. HBV - Hepatitis B • Symptoms • flu-like symptoms • fatigue • abdominal pain • loss of appetite • nausea, vomiting • joint pain • jaundice Normal eyes Jaundiced eyes

17. HBV - Hepatitis B Unprotected sex with multiple partners Sharing needles during injecting drug use From infected mother to child during birth Sharps/needle sticks HBV Transmission

18. HCV - Hepatitis C The most common chronic bloodborne infection in the U.S. 3.9 million (1.8%) Americans infected; 2.7 million chronically infected 25,000 new infections per year (2001) Leading cause of liver transplantation in U.S. 8,000-10,000 deaths from chronic disease/year No broadly effective treatment No vaccine available Copyright 1998 Trustees of Dartmouth College Healthy human liver Hepatitis C liver General Facts A healthy human liver contrasted with a liver from an individual who died from hepatitis C. Note the extensive damage and scarring from chronic liver disease.

19. HCV - Hepatitis C Age-related Clinical Features

20. HCV - Hepatitis C • Symptoms • flu-like symptoms • jaundice • fatigue • dark urine • abdominal pain • loss of appetite • nausea

21. HCV - Hepatitis C HCV Transmission • Injecting drug use • Hemodialysis (long-term) • Blood transfusion and/or organ transplant before 1992 • From infected mother to child during birth • Occupational exposure to blood - mostly needlesticks • Sexual or household exposures - rare

22. Fragile – few hours in dry environment Attacks the human immune system Cause of AIDS >1 million infected persons in U.S. No cure; no vaccine available yet Human Immunodeficiency Virus (HIV) HIV - seen as small spheres on the surface of white blood cells General Facts

23. Human Immunodeficiency Virus (HIV) Many have no symptoms or mild flu-like symptoms Most infected with HIV eventually develop AIDS Incubation period 10-12 yrs Opportunistic infections & AIDS-related diseases - TB, toxoplasmosis, Kaposi’s sarcoma, oral thrush (candidiasis) Treatments are limited; do not cure HIV Infection  AIDS

24. Sexual contact Sharing needles and/or syringes From HIV-infected women to their babies during pregnancy or delivery Breast-feeding Needlesticks Human Immunodeficiency Virus (HIV) HIV Transmission

25. means reasonably anticipated skin, eye, mucous membrane, or parenteral (piercing of the skin) contact with blood or OPIM that may result from the performance of an employee's duties Transmission of BBPs Occupational Exposure Exposure Incident • is a specific contact with blood or OPIM that is capable of transmitting a bloodborne disease

26. Health Care Workers and BBPs Most common: needlesticks Cuts from other contaminated sharps (scalpels, broken glass, etc.) Contact of mucous membranes (eye, nose, mouth) or broken (cut or abraded) skin with contaminated blood Causes of percutaneous injuries with hollow-bore needles, by % total percutaneous injuries Handling/transferring specimens Improperly disposed sharp Manipulating needle in patients Other Disposal-related causes 4% 5% 10% 27% 12% 8% 8% 11% 10% 5% IV line-related causes Collision w/health care worker or sharp Clean-up Handling or passing device during or after use Recapping Source: CDC [1999] Occupational Transmission

27. Health Care Workers and BBPs HBV: 6%-30% HCV: 1.8%(range 0%-7%) HIV: 0.3% Occupational Transmission Risk of infection following needlestick/cut from a positive (infected) source:

28. Exposure determination Exposure controls Training and Hazard Communication Hepatitis B Vaccine Post exposure evaluation & follow-up Recordkeeping Exposure Control Plan Exposure Control Plan To eliminate/minimize your risk of exposure Located at: (state exact location(s))

29. In which job classifications here are ... All employees occupationally exposed? Some employees occupationally exposed? What are the tasks with exposure? *Determine exposure without considering the use of PPE. Exposure Determination Who is at risk on-the-job?

30. Exposure Determination The following are job classifications in our establishment in which ALL employees have occupational exposure to bloodborne pathogens: The following are job classifications in our establishment in which SOME employees have occupational exposure to bloodborne pathogens:

31. Exposure Controls Universal precautions (or equivalent system*) Equipment and Safer Medical Devices Work practices Personal protective equipment Reducing your risk • Housekeeping • Laundry handling • Hazard communication- labeling • Regulated Waste

32. Exposure Controls UNIVERSAL PRECAUTIONS – Asystem of infection control: TREAT ALL HUMAN BLOODANDOPIM AS IF KNOWN TO BE INFECTIOUS WITH A BLOODBORNE DISEASE.

33. Sharps disposal containers Closable Puncture-resistant Leak-proof Labeled or color-coded Upright, conveniently placed in area where sharps used DO NOT OVERFILL! Exposure Controls Equipment and Safer Medical Devices • Physical guard

34. Exposure Controls Equipment and Safer Medical Devices • Barrier Shields

35. Exposure Controls Equipment and Safer Medical Devices • Environmental Controls Ventilation hood

36. Safer Medical Devices Sharps with engineered sharps injury protections (SESIP) Needleless systems Self-blunting needles Plastic capillary tubes Exposure Controls Unprotected position Protected position Equipment and Safer Medical Devices • Other Devices Example of needle guard with protected sliding sheath that is pushed forward after use and locks (with some designs the shield must be twisted to engage the lock).

37. Exposure Controls Safe Work Practices Do the job/task in safer ways to minimize any exposure to blood or OPIM: • Don’t bend, recap, or remove needles or other sharps • Don’t shear or break needles • Place contaminated reusable sharps immediately in appropriate containers until properly decontaminated

38. Exposure Controls Safe Work Practices • Do not pipette or suction blood or OPIM by mouth. • Wash hands after each glove use and immediately or ASAP after exposure. • Remove PPE before leaving work area.

39. Exposure Controls Safe Work Practices • Do not eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in any work areas where there is the possibility of exposure to blood or OPIM. • Do not place food or drink in refrigerators, freezers, shelves, cabinets, or on countertops or bench tops in any work areas.

40. Exposure Controls Safe Work Practices Clean-up of spills and broken glassware/sharps contaminated with blood or OPIM • Wear protective eyewear and mask if splashing is anticipated. • Remove glass and other sharps materials using a brush and dust pan, forceps, hemostat, etc. Do not use your hands. • Properly discard all materials into a sharps or puncture-resistant biohazardous waste container. • Use paper/absorbent towels to soak up the spilled materials.

41. Exposure Controls Safe Work Practices Clean-up of spills and broken glassware/sharps (cont.) • Clean the area with 10% bleach orEPA-registered disinfectant. • Saturate the spill area with disinfectant. Leave for 10 minutes (or as specified by product manufacturer) or allow to air dry. • Properly dispose of paper towels and cleaning materials into proper waste containers.

42. Gloves Lab coats Gowns Shoe covers Exposure Controls Personal Protective Equipment (PPE) You must wear all required PPE. (State your company’s name) provides you with the following PPE at no cost: • Face shields or • Masks and eye protection • Resuscitation devices PPE Contact: (name of responsible person or department)

43. Latex Nitrile Vinyl Utility Exposure Controls Nitrile and vinyl gloves Boxes of latex gloves in glove dispensing rack Personal Protective Equipment (PPE) • Gloves

44. Exposure Controls • Grasp near cuff of glove and turn it inside out. Hold in the gloved hand. • Place fingers of bare hand inside cuff of gloved hand and also turn inside out and over the first glove. • Dispose gloves into proper waste container. • Clean hands thoroughly with soap and water (or antiseptic hand rub product if handwashing facilities not available). Personal Protective Equipment (PPE) Remove gloves safely and properly video clip

45. Safe and proper glove removal

46. Exposure Controls Lab coat Gown Apron Surgical cap or hood Shoe cover or boot Fully encapsulated suit Personal Protective Equipment (PPE) • Protective clothing

47. Exposure Controls Safety glasses with side shields Splash goggles Face shield Mask Personal Protective Equipment (PPE) • Eye-Face Protection and Masks

48. Exposure Controls Personal Protective Equipment (PPE) • Resuscitation Devices

49. Written cleaning and decontamination schedule and procedures Approved disinfectant – bleach, EPA-approved Contaminated waste disposal methods Laundry Exposure Controls DISINFECTANT Housekeeping Maintain a clean and sanitary workplace

50. Contaminated articles:(list items that are laundered) Handle as little as possible Bag/containerize where used Don’t sort or rinse where used Place in leak-proof, labeled or color-coded containers or bags Wear PPE when handling and/or sorting: Gloves Gown Schedule (Time, location) Exposure Controls Laundry